Establishing a Lingua Franca Diabetica (I)

Lingua franca: a common language by which communication can be conducted between parties who speak different native tongues.

A recent video clip on Manny’s blog which sounded (to my non-hispanophone ears) like a fugue on American (mis)pronunciation of Spanish place names reminded me of similar issues I’ve had with French place names in the United States (sorry, but I read “Bwahz” – not “Boy Zee” – and “Dey Mwahnn” rather than “Duh Moynz”) – and of the more senior of my high school French teachers, whose distinct Brooklyn accent sadly disadvantaged his subject knowledge and teaching skills.

On the surface, it’s humorous. Dig a little deeper, and frustrations can mount. One formative experience for me was in university, shortly after the Ayatollah Khomeini seized power in Iran. Our High Holy Day prayer services were mostly student-run, and my usual part was to line up people for the various “honors” that this service entails.

One gentleman worshipping with us that year had just managed to escape from Iran and knew no English whatsoever; he communicated with us in Hebrew and in French. The head of our minyan reported difficulty communicating in either of those two languages. My own French was a bit stronger than my colleague’s, but it took rather a bit of gesturing and misunderstandings before we learned a couple of key things: one, that certain details of the service differed from what this gentleman was used to in his home country, and two, that one particular French sound – a high, rounded “u” sound which exists neither in English nor in Hebrew or Persian – is interpreted differently in English than in Persian. The allophonic difference resulted in the word meaning “to kill, slay, or murder” (tuer) sounding instead like the word meaning “to tie up” (tier). Quite a difference!

It’s the same way with diabetes. How we, our doctors, and our families speak of – and interpret – our states of health, our regimens of care, our medications, and the various flotsam and jetsam of diabetes care can vary greatly between individuals, types of diabetes, and the various biological, medical, and psychological specialties with which we interact. As an example: does “controlling your diabetes” mean staying within the ADA’s two-hour postprandial target of under 180 mg/dl, the Joslin Institute’s somewhat stricter ranges for fasting, pre- and postprandial, and retiring blood glucose levels, the “tight blood glucose control” of never dipping below 70 or rising beyond 110, or just maintaining an A1c under 7.0? Establishing a lingua franca with our families and our health care team – a set of words and terms on which we can agree upon the definitions and implications – is paramount to being able to work productively and coherently to maintain our health.

The thought train continues here.